上期回顾
温故而知新专栏 | 偏头痛的病因及生理功能失衡(上)
上期我们一起了解了偏头痛的病因、症状及生理失衡,本期我们一起学习偏头痛的功能医学干预。
偏头痛的临床治疗
发作期常用药物
2. 特异性药物:如麦角类制剂和曲普坦类药物。非甾体类抗炎药(NSAIDs):如对乙酰氨基酚、萘普生、布洛芬等。阿片类药物:如哌替啶。麦角类制剂:麦角胺和二氢麦角胺(DHE),能终止偏头痛的急性发作。曲普坦类:常用药物有舒马曲普坦、那拉曲普坦、利扎曲普坦、佐米曲普坦、阿莫曲普坦。
发作期的治疗
2. 中重度头痛:可直接选用偏头痛特异性治疗药物以尽快改善症状,部分患者虽有严重头痛但以往发作对NSAIDs反应良好者,仍可选用NSAIDs。
3. 伴随症状:恶心、呕吐是偏头痛突出的伴随症状,也是药物常见的不良反应。因此合用止吐剂(如甲氧氯普胺即胃复安肌内注射)是必要的,对于严重呕吐者可给予小剂量奋乃静、氯丙嗪。有烦躁者可给予苯二氮䓬类药物以促使患者镇静和入睡。
预防治疗
2. 药物治疗:① β肾上腺素能受体阻滞剂,如普萘洛尔、美托洛尔;② 钙离子拮抗剂,如氟桂利嗪、维拉帕米;③ 抗癫痫药,如丙戊酸、托吡酯、加巴喷丁;④ 抗抑郁药,如阿米替林、丙米嗪、氟西汀;⑤ 5-HT受体拮抗剂,如苯噻啶。其中,普萘洛尔、阿米替林和丙戊酸三种在结构上无关的药物,是预防性治疗的支柱,一种药物无效可选用另一种药物。
3. 生活方式改变:注意生活规律,避免过度疲劳、压力过大、防治亚健康状态等。找出头痛诱发及缓解的因素,并尽可能避免。如避免某些食物,保持规律的作息时间、规律饮食。不论是在工作日,还是周末抑或假期,坚持这些方案对于减轻头痛发作非常重要,接受这些建议对30%患者有帮助。另有人倡导有规律的锻炼,如长跑等,可有效地减少头痛发作。
偏头痛的功能医学辅助干预:
寻找和治愈偏头痛的原因
食物敏感和/或肠道功能失衡
图2 尿液有机酸检测肠道有害菌及酵母菌超标
图3 肠道5R疗法
寻找化学触发器
▲ 治疗方法:去除添加剂、甜味剂、亚硫酸盐和加工食品。吃富含全食物和植物营养素的饮食。
荷尔蒙失调
▲ 检测:荷尔蒙检测或检测雌激素过多。
▲ 治疗:吃全食物、低血糖负荷、高植物营养素饮食,包括亚麻、大豆和十字花科蔬菜,如西兰花、卷心菜、抱子甘蓝和花椰菜。使用草药如圣洁莓,以及镁和维生素B6。避免酒精、咖啡因、糖和精制碳水化合物。锻炼和减压技巧也有帮助。
镁缺乏症
▲ 检测:检查红细胞镁水平(见图4)。
▲ 治疗:甘氨酸镁、柠檬酸镁或天冬氨酸镁的剂量可缓解症状。如果患有肾脏疾病,应在严格检测下应用。
图4 红细胞内镁检测
线粒体失衡
▲ 检测:检查尿有机酸有助于评估线粒体的功能和能量产生。
▲ 治疗:每天两次服用 400 mg核黄素 (B2) 和每天服用100-400mg辅酶 Q10 会有所帮助,就像其他支持线粒体的治疗一样。
营养干预
营养干预可以有效地解决慢性偏头痛,并帮助改善患者的生活质量。特别是,在饮食中加入特定营养素的营养干预可以帮助支持线粒体功能。
THE END
参考文献
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